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Limitations and exclusions

Covered services, limitations and exclusions

TRICARE Prime covers most care that is medically necessary and considered proven. Some types of care are not covered at all, and there are special rules and limits for certain types of care. TRICARE policies are very specific about which services are covered and which are not. It is in your best interest to take an active role in verifying coverage.

This information outlines your options for:

  • Outpatient services
  • Inpatient services
  • Clinical preventive services
  • Behavioral healthcare services
  • Outpatient behavioral healthcare services
  • Telemental health program
  • Inpatient behavioral healthcare services
  • Substance use disorder services
  • Dental options
  • Hospice care
  • Maternity services
  • ECHO
  • Pharmacy program
  • Pharmacy services
  • Services/procedures with significant limits
  • Exclusions